'We were just being cheap': Kan. county seeks $568K to improve EMS
Sedgwick County reverses course on a 2018 study that led to staffing shortage, slow response times and employee burnout
By Chance Swaim
The Wichita Eagle
SEDGWICK COUNTY, Kan. — Sedgwick County has officially abandoned an Emergency Medical Services staffing plan and internal study that contributed to a massive paramedic shortage, dangerously slow response times and burnout among EMS employees.
County Manager Tom Stolz is asking county commissioners to approve adding 31 paramedics to the EMS budget at a cost of $568,644, a move that would reverse a 2018 staffing plan that sought to replace 35 paramedics with lower-paid and less-qualified EMTs to save money.
The cost-cutting maneuver spurred a public safety crisis across Wichita and surrounding areas, as reported in The Eagle's "Unresponsive" investigative series in 2021. That investigation spurred the resignation of two EMS leaders and a restructuring of the department.
The county has been slowly moving away from the staffing plan for two years. But county leaders did not officially dismiss it until this month.
County commissioners will decide whether to fund the change in August.
EMS Chief Kevin Lanterman said the move is expected to help boost morale in the department, reduce paramedic burnout and return the department to its former reputation as one of the premier ambulance services in the United States.
"We want to keep our people healthy, and we want to keep them here," Lanterman said.
The reversal is significant because it allows Sedgwick County EMS to add paramedics to its staffing table, giving the department budget authority to hire the number of paramedics it had before former director Dr. John Gallagher took over in 2019.
Gallagher had endorsed the paramedic cuts when he was the EMS medical director, writing in the study that eliminating 35 paramedic positions by 2021 "would be expected to have no effect, or perhaps a positive effect, on patient care within our county," records show.
Instead, emergency patients found themselves waiting longer for life-saving care. A mass exodus and open revolt by EMS workers against Gallagher ensued. Many of the paramedics who remained on staff were overworked, burnt out and fed up.
Gallagher was forced out in July 2021. He has since moved to Hawaii, where he works as a financial planner for physicians at Integrated Wealthcare. Lanterman, a longtime Sedgwick County paramedic, took over as EMS chief in June 2022.
EMS response times improving slowly
Since Lanterman's appointment, response times have slowly improved, although they remain worse than in 2019, records show. Staffing numbers have also improved, but Lanterman said it could be at least two more years before the county can hire enough paramedics to replace those who left under Gallagher.
County Manager Tom Stolz said at a May 10 budget hearing that EMS has been in a "tweener situation" on its ambulance crew configuration, as it does not have enough paramedics to staff each ambulance with two paramedics.
"We never said we wanted to do it that way," Lanterman, who was a paramedic when the county made the switch, said of the EMT-paramedic crews. "We were kind of forced to because we had no paramedics to hire."
Stolz announced the reversal after Commissioner Ryan Baty asked whether the county was officially abandoning the paramedic-EMT staffing plan.
"We're clearing the air on that today," Stolz said. "The chief wants to go to a two-paramedic system, so yes, we're making philosophical changes."
EMS study didn't take 'into account the human factor'
Lanterman said the 2018 study may have looked good on paper but it made little sense to paramedics in the field.
"My perspective is that study — I don't think took into account the human factor of the people working," Lanterman said. "They were solely looking at outcomes, and I'm not sure what they base those on. On calls, you have critical calls that need multiple advanced-life support procedures done at the same time.
"If you have one paramedic there, they have to choose: Am I going to start that IV and give the patient the medication they need, or am I going to take care of that airway they need? I have to choose. I don't have another paramedic there to do the advanced skill."
Sedgwick County Commissioner Jim Howell, who spearheaded efforts to reform EMS in 2021 and whose daughter-in-law works for EMS, said he never agreed with the 2018 study and he supports moving back to dual-paramedic ambulance crews.
"We were just being cheap," Howell said. "We had some tough budget years, and this was a way to reduce the budget in those years by not paying paramedics. So the $500,000 request gets us back to what we should be."
Since Gallagher stepped down in July 2021, Sedgwick County EMS has hired an additional eight field paramedics, bringing the total to 113, according to records provided by the county. The department plans to hire at least 11 more paramedics within the next year.
The goal is to fill the Sedgwick County EMS field staff with 151 paramedics and 10 EMTs, which Lanterman said could take a couple of years to realize. The county budget currently allows 120 field paramedics, 20 EMTs and 15 EMT-to-paramedic recruits.
"We really haven't added (full-time positions) since 2017, and our call volume has gone up almost 6,000 calls since then," Lanterman said.
Lanterman said it's important to continue employing full- and part-time EMTs to help fill in for paramedics and to establish a long-term pipeline of paramedics.
County changes plans to address EMS crisis
The change back to dual-paramedic ambulances is the latest about-face by Sedgwick County in response to the EMS crisis. After the Eagle report, Stolz dropped the physician-led model the county adopted in 2019 against the wishes of a majority of EMS employees, who circulated a petition in an attempt to block the consolidation of the Office of the Medical Director and the EMS Service Director into a single leadership role held by Gallagher.
The county later established an EMT-to-paramedic scholarship program, increased paramedic pay and added $2,500 sign-on bonuses for new hires. Under Lanterman, EMS also began publicly reporting its performance metrics, something Gallagher stopped doing when he took over.
The Sedgwick County EMS dashboard, created in late 2021, is one of the most transparent online portals in Wichita-area local government. It provides detailed monthly updates on a wide range of EMS performance metrics, from how much the department spends on baby aspirin to response times to cardiac arrest outcomes.
But response time data continues to undercount how long it takes to receive emergency care from the time a person calls 911. The data only shows how long it takes an ambulance crew to arrive on the scene after it is dispatched. It does not include how long it takes a dispatcher to assign an emergency call to a crew and how long it takes a crew to make contact with a patient after arriving at an address, two key components that can add several minutes to an EMS response.
County officials have argued that EMS has no control over how soon calls are dispatched, so it would be unfair to add that time to ambulance response times. But EMS staffing affects the number of ambulances available at any given time and how many calls 911 dispatchers have to place on hold while they wait for an ambulance to become available.
BEHIND OUR REPORTING
How we did this story
Eagle reporters sifted through 495,729 records documenting ambulance response times from Sedgwick County 911 and Sedgwick County EMS to determine how quickly patients received care between 2017 and mid-2021. To track EMS staffing changes, we compared detailed employee rosters. Ambulance shortage data came from analyzing more than 2,700 records pulled from the county's MARVLIS software. Hundreds of emails, more than 10 hours of audio recordings of meetings between county officials and EMS employees in 2019 and 2021, 911 audio, and our own interviews with more than 50 people informed our reporting. We obtained the records through Kansas Open Records Act requests and from county sources.
Why did we report this story?
Sedgwick County EMS has been saving lives since 1975. But Sedgwick County EMS employees have warned county leaders that poor leadership is driving away paramedics, cutting down the number of ambulances on the street and delaying response times to life-saving rescues.
Who did we speak to?
We talked to families affected by EMS response times. We interviewed past and present frontline EMS workers, EMS middle management, advanced paramedics, captains, lieutenants, shift commanders, training staff, paramedic students and EMS and 911 administrators. We talked to all five Sedgwick County Commissioners and the county manager. We reached out to the nation's leading experts in EMS response times.
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